Self-management programmes in TMD: results from an international Delphi process

Abstract

Self-management (SM) programmes are commonly used for initial treatment of patients with temporomandibular disorders (TMD). The programmes described in the literature, however, vary widely with no consistency in terminology used, components of care, or their definitions. The aims of this study were, therefore, to: construct an operationalized definition of self-management appropriate for the treatment of patients with TMD; identify the components of that self-management currently being used; create sufficiently clear and non-overlapping standardized definitions for each of those components. A four-round Delphi process with eleven international experts in the field of TMD was conducted to achieve these aims. In the first round, the participants agreed upon six principal concepts of self-management. In the remaining three rounds, consensus was achieved upon the definition and the six components of self-management. The main components identified and agreed upon by the participants to constitute the core of a SM programme for TMD were: education; jaw exercises; massage; thermal therapy; dietary advice and nutrition; and parafunctional behaviour identification, monitoring, and avoidance. This Delphi process has established the principal concepts of self-management and a standardized definition has been agreed with the following components for use in clinical practice: education; self-exercise; self-massage; thermal therapy; dietary advice and nutrition; and parafunctional behaviour identification, monitoring, and avoidance. The consensus-derived concepts, definitions, and components of SM, offer a starting point for further research in order to advance the evidence base for, and clinical utility of, TMD SM.

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